Monika A Waszczuk1, Mark Zimmerman2, Camilo Ruggero3, Kaiqiao Li1, Annmarie MacNamara4, Anna Weinberg5, Greg Hajcak6, David Watson7, Roman Kotov8. 1. Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA. 2. Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA. 3. Department of Psychology, University of North Texas, Denton, TX, USA. 4. Department of Psychology, Texas A&M University, College Station, TX, USA. 5. Department of Psychology, McGill University, Montreal, Canada. 6. Department of Psychology, Stony Brook University, Stony Brook, NY, USA. 7. Department of Psychology, University of Notre Dame, Notre Dame, IN, USA. 8. Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA. Electronic address: roman.kotov@stonybrook.edu.
Abstract
BACKGROUND: Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms. AIM: To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses. METHODS: Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian). RESULTS: Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it. CONCLUSIONS: Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
BACKGROUND: Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms. AIM: To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses. METHODS: Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatricoutpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian). RESULTS: Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it. CONCLUSIONS:Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
Authors: Natacha Carragher; Robert F Krueger; Nicholas R Eaton; Kristian E Markon; Katherine M Keyes; Carlos Blanco; Tulshi D Saha; Deborah S Hasin Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2013-10-01 Impact factor: 4.328
Authors: Robert F Krueger; Roman Kotov; David Watson; Miriam K Forbes; Nicholas R Eaton; Camilo J Ruggero; Leonard J Simms; Thomas A Widiger; Thomas M Achenbach; Bo Bach; R Michael Bagby; Marina A Bornovalova; William T Carpenter; Michael Chmielewski; David C Cicero; Lee Anna Clark; Christopher Conway; Barbara DeClercq; Colin G DeYoung; Anna R Docherty; Laura E Drislane; Michael B First; Kelsie T Forbush; Michael Hallquist; John D Haltigan; Christopher J Hopwood; Masha Y Ivanova; Katherine G Jonas; Robert D Latzman; Kristian E Markon; Joshua D Miller; Leslie C Morey; Stephanie N Mullins-Sweatt; Johan Ormel; Praveetha Patalay; Christopher J Patrick; Aaron L Pincus; Darrel A Regier; Ulrich Reininghaus; Leslie A Rescorla; Douglas B Samuel; Martin Sellbom; Alexander J Shackman; Andrew Skodol; Tim Slade; Susan C South; Matthew Sunderland; Jennifer L Tackett; Noah C Venables; Irwin D Waldman; Monika A Waszczuk; Mark H Waugh; Aidan G C Wright; David H Zald; Johannes Zimmermann Journal: World Psychiatry Date: 2018-10 Impact factor: 49.548
Authors: Robert F Krueger; Roman Kotov; David Watson; Miriam K Forbes; Nicholas R Eaton; Camilo J Ruggero; Leonard J Simms; Thomas A Widiger; Thomas M Achenbach; Bo Bach; R Michael Bagby; Marina A Bornovalova; William T Carpenter; Michael Chmielewski; David C Cicero; Lee Anna Clark; Christopher Conway; Barbara DeClercq; Colin G DeYoung; Anna R Docherty; Laura E Drislane; Michael B First; Kelsie T Forbush; Michael Hallquist; John D Haltigan; Christopher J Hopwood; Masha Y Ivanova; Katherine G Jonas; Robert D Latzman; Kristian E Markon; Joshua D Miller; Leslie C Morey; Stephanie N Mullins-Sweatt; Johan Ormel; Praveetha Patalay; Christopher J Patrick; Aaron L Pincus; Darrel A Regier; Ulrich Reininghaus; Leslie A Rescorla; Douglas B Samuel; Martin Sellbom; Alexander J Shackman; Andrew Skodol; Tim Slade; Susan C South; Matthew Sunderland; Jennifer L Tackett; Noah C Venables; Irwin D Waldman; Monika A Waszczuk; Mark H Waugh; Aidan G C Wright; David H Zald; Johannes Zimmermann Journal: Ann Med Psychol (Paris) Date: 2021-01-08 Impact factor: 0.380
Authors: Christopher C Conway; Miriam K Forbes; Kelsie T Forbush; Eiko I Fried; Michael N Hallquist; Roman Kotov; Stephanie N Mullins-Sweatt; Alexander J Shackman; Andrew E Skodol; Susan C South; Matthew Sunderland; Monika A Waszczuk; David H Zald; Mohammad H Afzali; Marina A Bornovalova; Natacha Carragher; Anna R Docherty; Katherine G Jonas; Robert F Krueger; Praveetha Patalay; Aaron L Pincus; Jennifer L Tackett; Ulrich Reininghaus; Irwin D Waldman; Aidan G C Wright; Johannes Zimmermann; Bo Bach; R Michael Bagby; Michael Chmielewski; David C Cicero; Lee Anna Clark; Tim Dalgleish; Colin G DeYoung; Christopher J Hopwood; Masha Y Ivanova; Robert D Latzman; Christopher J Patrick; Camilo J Ruggero; Douglas B Samuel; David Watson; Nicholas R Eaton Journal: Perspect Psychol Sci Date: 2019-03-07
Authors: Monika A Waszczuk; Christopher J Hopwood; Benjamin J Luft; Leslie C Morey; Greg Perlman; Camilo J Ruggero; Andrew E Skodol; Roman Kotov Journal: Clin Psychol Sci Date: 2021-12-21
Authors: Vincent P Martin; Jean-Luc Rouas; Pierre Philip; Pierre Fourneret; Jean-Arthur Micoulaud-Franchi; Christophe Gauld Journal: Front Psychiatry Date: 2022-06-09 Impact factor: 5.435
Authors: David Watson; Holly F Levin-Aspenson; Monika A Waszczuk; Christopher C Conway; Tim Dalgleish; Michael N Dretsch; Nicholas R Eaton; Miriam K Forbes; Kelsie T Forbush; Kelsey A Hobbs; Giorgia Michelini; Brady D Nelson; Martin Sellbom; Tim Slade; Susan C South; Matthew Sunderland; Irwin Waldman; Michael Witthöft; Aidan G C Wright; Roman Kotov; Robert F Krueger Journal: World Psychiatry Date: 2022-02 Impact factor: 79.683
Authors: Roman Kotov; Katherine G Jonas; William T Carpenter; Michael N Dretsch; Nicholas R Eaton; Miriam K Forbes; Kelsie T Forbush; Kelsey Hobbs; Ulrich Reininghaus; Tim Slade; Susan C South; Matthew Sunderland; Monika A Waszczuk; Thomas A Widiger; Aidan G C Wright; David H Zald; Robert F Krueger; David Watson Journal: World Psychiatry Date: 2020-06 Impact factor: 49.548